No evidence of benefit for laminar flow in theatre for sling-assisted, implant-based breast reconstruction.

INTRODUCTION: Recent years have seen a large increase in the proportion and number of sling-assisted, implant-based breast reconstructions. These are associated with significant rates of loss of the reconstruction. Various methods have been suggested to reduce this loss rate. One such method is the use of operating theatres with laminar flow. The majority of cases of sling-assisted, implant-based breast reconstruction in south-east Scotland are performed in two adjacent theatres, one with laminar flow and one without. This provided the opportunity to assess whether there was any difference in outcome potentially attributable to laminar flow. METHODS: Patients undergoing sling-assisted, implant-based breast reconstruction between August 2013 and December 2018 were studied with follow up for at least 6 months. RESULTS: 307 patients underwent a total of 470 procedures. 247 procedures were performed with laminar flow and 223 without. There was no difference in the indications for mastectomy, incision used or rates of smoking or radiotherapy between the two groups. Implant loss occurred in 15.8% of procedures with laminar flow and 14.3% of those without (p = 0.66). Wound problems occurred in 27.5% of procedures with laminar flow and 27.8% of those without (p = 0.97). There was no significant difference in loss rates between surgeons, mastectomy indication, sling materials or with chemotherapy use. Increased loss rates were observed in smokers, with radiotherapy, with incisions other than transverse, with larger breasts and with increasing patient weight. CONCLUSION: This study finds no evidence of benefit for laminar flow in theatre for sling-assisted, implant-based breast reconstruction.

"Serpent" in the breast.

BACKGROUND: Dracunculus medinensis better known as guinea worm is the longest nematode infecting humans. Mature female worms migrate along subcutaneous tissue to reach the skin below the knee forming a painful ulcerating blister. Calcified male worm can occasionally be found in the retro peritoneum. Finding of a calcified worm in the breast tissue is very rare. We report a case of a fit and well African lady who was found to have a calcified guinea worm in the breast on a mammographic examination for investigation of a breast lump. METHODS: A 51 years old female, presented in the surgical outpatient clinic with a painless irregular lump under the right nipple on clinical examination. There were no skin changes, nipple discharge or axillary lymphadenopathy. Mammogram showed a calcified Guinea worm. RESULTS: No treatment was offered and a repeat mammogram after one year showed the same findings. She was discharged from the clinic without any follow up and will be screened routinely as per national guidelines CONCLUSION: Guinea worm can be included in the differential diagnosis of the breast lump especially in the endemic areas although the finding remains very rare.

Recent advances in the management of abdominal compartment syndrome.

Abdominal compartment syndrome is a systemic syndrome involving derangement in cardiovascular hemodynamics, respiratory and renal function as a result of sustained increase in intra-abdominal pressure. This results in multi-organ failure requiring prompt action and treatment. Presentation can be acute, chronic and acute on chronic. Initial diagnosis is clinical, confirmed by measurement of urinary bladder pressure. Treatment is abdominal decompression by laparostomy and delayed abdominal closure. Awareness among the surgeons has increased because laparoscopy has resulted in determination of intra-abdominal pressure as a readily measurable quantity. They have been able to appreciate the benefit of abdominal decompression by performing repeated planned laparotomies for trauma.

Massive hemoperitoneum caused by rupture of an aneurysm of the marginal artery of Drummond.

Aneurysms of visceral arteries are uncommon and their rupture is rare. We report a case of an aneurysm of the marginal artery of Drummond, which was complicated by rupture leading to massive hemoperitoneum. A selective superior mesenteric arteriogram suggested the possibility of segmental arterial mediolysis (SAM) as a possible etiology and this was confirmed by histological examination. This is the first report of symptomatic SAM of the marginal artery of Drummond to date. This case demonstrates that the marginal artery of Drummond should be considered during the angiographic explorations for the source of hemoperitoneum. Management options are discussed.